Individual provider Active NPI

Ryan Baca, PA

  • Physician Assistant
  • Fort Worth, TX
National Provider Identifier
1851886758
Registry record updated Feb 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA12081 Issued in TX
Practice address
800 5TH Ave Ste 500
Fort Worth, TX 76104-7304
Phone
(817) 250-4280
Fax
(817) 250-4281
NPI assigned
Jun 25, 2018
Last updated
Feb 28, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA12081 TX Primary

Addresses

Primary practice location

800 5TH Ave Ste 500
Fort Worth, TX 76104-7304

Mailing address

800 5TH Ave Ste 500
Fort Worth, TX 76104-7304
Phone (817) 250-4280

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rbaca1373766@Direct.TexasHealth.org Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180710001091 TX Practitioner - Physician Assistant 5092061895 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA12081TXMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Texas Health Physicians Group CurrentSince Aug 10, 2020 Accepting new patients
Texas Health Physicians Group CurrentSince Aug 10, 2020 Accepting new patients

Locations

1600 Hospital Pkwy
Bedford, TX 76022
Phone (817) 355-7803

1300 W Terrell Ave
Ste K230
Fort Worth, TX 76104
Phone (817) 250-7240

800 5th Ave
Ste 500
Ft Worth, TX 76104
Phone (817) 250-4280

Interoperability endpoints

  • Direct secure messaging: rbaca1373766@direct.texashealth.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646006400000",
    "number": "1851886758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 5TH AVE STE 500",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761047304",
            "telephone_number": "817-250-4280",
            "fax_number": "817-250-4281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 5TH AVE STE 500",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761047304",
            "telephone_number": "817-250-4280",
            "fax_number": "817-250-4281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACA",
        "first_name": "RYAN",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-25",
        "last_updated": "2022-02-28",
        "certification_date": "2022-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA12081",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rbaca1373766@Direct.TexasHealth.org",
            "affiliation": "N",
            "endpointDescription": "Health Information Exchange (HIE)",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "800 5th Ave Ste 500",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761047304",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

Verify at the official NPI Registry.